Exploring Head Nurse Leadership at Multiple Levels to Prevent MDROs in ICUs: A Multicentre Grounded Theory Approach to create the BRIDGE_IPC framework

The BRIDGE-IPC framework emerges from a qualitative Grounded Theory study involving 34 ICU professionals across two hospitals, identifying head nurse leadershi…The BRIDGE-IPC framework emerges from a qualitative Grounded Theory study involving 34 ICU professionals across two hospitals, identifying head nurse leadership as the central element in managing infections from multidrug-resistant organisms. Four key themes shape this leadership: building a safe organisation, adopting flexible and context-sensitive strategies, cultivating relational dynamics that foster a sense of belonging, and modulating professional behaviours. The framework operates across three interconnected levels — macro policies, meso leadership, and micro individual and team behaviours. Head nurses act as system mediators, transforming individual knowledge into shared practices through "virtual knowledge bridges," ultimately reinforcing staff adherence to IPC protocols and improving patient safety.